Trigeminal neuralgia, or tic douloureux, is a chronic neurological condition that causes severe, sudden-onset facial pain. This pain typically stems from the trigeminal nerve, which controls facial sensation and transmits nerve signals between the face and the brain.
The trigeminal nerve comprises two cranial nerves which connect the brain and brain stem to the upper body– head, neck, and torso. Each of these nerves serves one side of the body and brain and is split into three components:
Ophthalmic: upper section of the nerve which provides feeling or sensation to the forehead and scalp.
Maxillary: middle section of the nerve which provides feeling or sensation to the cheeks, upper lip, sides of the nose, teeth, and gums.
Mandibular: lower section of the nerve which provides feeling or sensation to the lower jaw, lower lip, teeth, and gums.
Trigeminal neuralgia can affect any part of the trigeminal nerve.
Trigeminal neuralgia can affect any part of the trigeminal nerve and usually affects only one part of the face (unilateral); however, in rare cases, both sides of the face can be affected. This is known as bilateral trigeminal neuralgia.
There are two main types of trigeminal neuralgia, these are:
Type 1: also known as typical trigeminal neuralgia, and is characterised by intermittent sharp and intense pain facial pain, which typically lasts between 2 seconds and 2 minutes. These pain attacks are sporadic but can last for two hours in total.
Type 2: also known as atypical trigeminal neuralgia, and is characterised by a constant stabbing or burning sensation on your face. The pain is typically less intense than type 1 but is more widespread.
What causes trigeminal neuralgia?
Trigeminal neuralgia is primarily caused by irritation or damage to the trigeminal nerve.
Irritation of the trigeminal nerve may result from:
Compression: the most common cause of trigeminal neuralgia is the compression or pressure of the trigeminal nerve by nearby blood vessels. This causes the trigeminal nerve to malfunction, resulting in trigeminal neuralgia.
Structural issues: in some cases, structural abnormalities in your brain can contribute to trigeminal neuralgia. These may include tumours or cysts that affect the nerve’s function.
Surgical procedures: certain procedures, such as oral or sinus surgery, can inadvertently damage the trigeminal nerve, triggering symptoms.
Multiple sclerosis (MS): underlying conditions such as multiple sclerosis are also associated with trigeminal neuralgia. MS results in the deterioration of the protective covering (myelin sheath) of nerve fibres, causing them to become damaged and malfunction.
Multiple sclerosis damages the protective covering/myelin sheath of nerves, causing them to malfunction.
What are the symptoms of trigeminal neuralgia?
The symptoms of trigeminal neuralgia include:
Sporadic intense facial pain attacks lasting between 2 seconds to 2 minutes are usually seen in individuals with type 1 or typical trigeminal neuralgia
Constant stabbing or burning sensation lasting for days or weeks, usually seen in individuals with type 2 or atypical trigeminal neuralgia
Facial twitching or spasms which can happen on one or both sides of the face
Yes, trigeminal neuralgia is one of the most painful medical conditions. The intensity of the pain can be so severe that it can significantly disrupt your daily life, causing anxiety and fear of triggering an episode.
Who is at risk of trigeminal neuralgia in Singapore?
Trigeminal neuralgia can affect individuals of any age and background in Singapore. However, some factors may increase your risk of developing this condition. These risk factors include:
Gender:women are more frequently affected by trigeminal neuralgia than men.
Medical conditions: medical conditions such as multiple sclerosis significantly increase your risk of developing trigeminal neuralgia.
Women above 50 are more likely to develop trigeminal neuralgia than men.
How is trigeminal neuralgia diagnosed?
Diagnosing trigeminal neuralgia is a comprehensive process that involves several key steps:
Medical history and physical examination: this may help your neurologist identify possible causes of your trigeminal neuralgia. Inform your neurologist about your symptoms, frequency, possible triggers, and duration. Your neurologist will also conduct a physical and neurological assessment of your symptoms.
Antiseizure medication: if your neurologist suspects you have type 1 (typical) trigeminal neuralgia, your symptoms should improve with antiseizure/anticonvulsant medications.
Tricyclic antidepressants: if your neurologist suspects you have type 2(atypical) trigeminal neuralgia, your symptoms should improve with tricyclic antidepressants.
What are the treatment options for trigeminal neuralgia in Singapore?
In Singapore, the treatment options for trigeminal neuralgia are:
Medications: antiseizure drugs will be prescribed for type 1 (typical) trigeminal neuralgia to reduce the frequency and severity of pain episodes. For type 2 (atypical trigeminal neuralgia), tricyclic antidepressants will be prescribed to alleviate symptoms. Botulinum toxin injections can also temporarily block the nerve signals responsible for pain.
Surgical interventions: surgery may be necessary when medications are ineffective. Surgical procedures may involve microvascular decompression (MVD) – where the blood vessel that is compressing the trigeminal nerve is located and moved, gamma knife radiosurgery (brain stereotactic radiosurgery) – where radiation is used to destroy the root of the trigeminal nerve.
Rhizotomy techniques: examples include balloon compression and glycerol injections. Ballon compression involves guiding a balloon through a hollow needle to the site of your trigeminal nerve. The balloon is then inflated with enough pressure to damage the trigeminal nerve. Glycerol injections involve the injection of sterile glycerol to damage the trigeminal nerve.
Gamma knife radiosurgery is a surgical treatment for trigeminal neuralgia where radiation destroys the root of the trigeminal nerve.
Frequently asked questions
Is trigeminal neuralgia treatable?
Yes, trigeminal neuralgia is treatable and can be effectively managed with various treatment options.
Is trigeminal neuralgia a progressive condition?
Trigeminal neuralgia is typically not progressive because it does not worsen over time. However, the severity and frequency of pain episodes can vary among individuals. Effective treatment can help manage these symptoms.
